Rule2026-04797
Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program; Correction
Primary source
Metadata and text below are from the Federal Register, a public-domain U.S. government work. Always verify the official published version before relying on it for any legal matter.
Published
March 12, 2026
Effective
March 12, 2026
Issuing agencies
Health and Human Services DepartmentCenters for Medicare & Medicaid Services
Abstract
This document corrects typographical and technical errors in the final rule that appeared in the November 5, 2025 Federal Register titled "Medicare and Medicaid Programs; CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; and Medicare Prescription Drug Inflation Rebate Program" (hereinafter referred to as the CY 2026 PFS final rule), specifying finalized changes to the Medicare physician fee schedule (PFS) that is applicable for calendar year (CY) 2026, and other changes to Medicare Part B payment policies.
Full Text
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<title>Federal Register, Volume 91 Issue 48 (Thursday, March 12, 2026)</title>
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[Federal Register Volume 91, Number 48 (Thursday, March 12, 2026)]
[Rules and Regulations]
[Pages 12071-12082]
From the Federal Register Online via the Government Publishing Office [<a href="http://www.gpo.gov">www.gpo.gov</a>]
[FR Doc No: 2026-04797]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 410, 414, 424, 425, 427, 428, 495, and 512
[CMS-1832-F2]
RIN 0938-AV50
Medicare and Medicaid Programs; CY 2026 Payment Policies Under
the Physician Fee Schedule and Other Changes to Part B Payment and
Coverage Policies; Medicare Shared Savings Program Requirements; and
Medicare Prescription Drug Inflation Rebate Program; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Correcting amendments.
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SUMMARY: This document corrects typographical and technical errors in
the final rule that appeared in the November 5, 2025 Federal Register
titled ``Medicare and Medicaid Programs; CY 2026 Payment Policies Under
the Physician Fee Schedule and Other Changes to Part B Payment and
Coverage Policies; Medicare Shared Savings Program Requirements; and
Medicare Prescription Drug Inflation Rebate Program'' (hereinafter
referred to as the CY 2026 PFS final rule), specifying finalized
changes to the Medicare physician fee schedule (PFS) that is applicable
for calendar year (CY) 2026, and other changes to Medicare Part B
payment policies.
DATES: Effective March 12, 2026.
Applicability date: This document is applicable to January 1, 2026.
FOR FURTHER INFORMATION CONTACT:
<a href="/cdn-cgi/l/email-protection#78351d1c111b190a1d2810010b111b1119163e1d1d2b1b101d1c0d141d381b150b5610100b561f170e"><span class="__cf_email__" data-cfemail="1a577f7e73797b687f4a7263697379737b745c7f7f4979727f7e6f767f5a79776934727269347d756c">[email protected]</span></a>, for any issues not
identified below. Please indicate the specific issue in the subject
line of the email. For all questions related to reporting a service on
a claim, please contact your Medicare Administrative Contractor.
Michael Soracoe, Morgan Kitzmiller, or
<a href="/cdn-cgi/l/email-protection#135e76777a70726176437b6a607a707a727d55767640707b7677667f7653707e603d7b7b603d747c65"><span class="__cf_email__" data-cfemail="5a173f3e33393b283f0a3223293339333b341c3f3f0939323f3e2f363f1a39372974323229743d352c">[email protected]</span></a>, for issues related to
practice expense, work RVUs, conversion factor, and PFS specialty-
specific impacts.
Hannah Ahn, or <a href="/cdn-cgi/l/email-protection#e3ae86878a80829186b38b9a908a808a828da58686b0808b8687968f86a3808e90cd8b8b90cd848c95"><span class="__cf_email__" data-cfemail="cc81a9a8a5afadbea99ca4b5bfa5afa5ada28aa9a99fafa4a9a8b9a0a98cafa1bfe2a4a4bfe2aba3ba">[email protected]</span></a>, for issues
related to potentially misvalued services under the PFS.
Julie Rauch, or <a href="/cdn-cgi/l/email-protection#e6ab83828f85879483b68e9f958f858f8788a08383b5858e8382938a83a6858b95c88e8e95c8818990"><span class="__cf_email__" data-cfemail="f9b49c9d909a988b9ca991808a909a909897bf9c9caa9a919c9d8c959cb99a948ad791918ad79e968f">[email protected]</span></a>, for
issues related to Malpractice RVUs.
Morgan Kitzmiller, Terry Simananda, or
<a href="/cdn-cgi/l/email-protection#2b664e4f42484a594e7b4352584248424a456d4e4e7848434e4f5e474e6b48465805434358054c445d"><span class="__cf_email__" data-cfemail="8ac7efeee3e9ebf8efdae2f3f9e3e9e3ebe4ccefefd9e9e2efeeffe6efcae9e7f9a4e2e2f9a4ede5fc">[email protected]</span></a> for issues related to
Geographic Practice Cost Indices.
Mikayla Murphy, or <a href="/cdn-cgi/l/email-protection#b7fad2d3ded4d6c5d2e7dfcec4ded4ded6d9f1d2d2e4d4dfd2d3c2dbd2f7d4dac499dfdfc499d0d8c1"><span class="__cf_email__" data-cfemail="94d9f1f0fdf7f5e6f1c4fcede7fdf7fdf5fad2f1f1c7f7fcf1f0e1f8f1d4f7f9e7bafcfce7baf3fbe2">[email protected]</span></a>, for
issues related to direct supervision using two-way audio/video
communication technology, telehealth, and other services involving
communications technology.
Erick Carrera, or <a href="/cdn-cgi/l/email-protection#e0ad85848983819285b0889993898389818ea68585b383888584958c85a0838d93ce888893ce878f96"><span class="__cf_email__" data-cfemail="276a42434e44465542774f5e544e444e464961424274444f4243524b4267444a54094f4f5409404851">[email protected]</span></a>, for
issues related to office/outpatient evaluation and management visit
inherent complexity add-on and Digital Mental Health Treatment
services.
Maya Peterson, Terry Simananda, or
<a href="/cdn-cgi/l/email-protection#f4b991909d97958691a49c8d879d979d959ab29191a7979c9190819891b4979987da9c9c87da939b82"><span class="__cf_email__" data-cfemail="a8e5cdccc1cbc9dacdf8c0d1dbc1cbc1c9c6eecdcdfbcbc0cdccddc4cde8cbc5db86c0c0db86cfc7de">[email protected]</span></a>, for issues related to payment
for advanced primary care management services.
Sarah Leipnik, or <a href="/cdn-cgi/l/email-protection#c68ba3a2afa5a7b4a396aebfb5afa5afa7a880a3a395a5aea3a2b3aaa386a5abb5e8aeaeb5e8a1a9b0"><span class="__cf_email__" data-cfemail="c18ca4a5a8a2a0b3a491a9b8b2a8a2a8a0af87a4a492a2a9a4a5b4ada481a2acb2efa9a9b2efa6aeb7">[email protected]</span></a>, for
issues related to global surgery payment accuracy.
Pamela West, or <a href="/cdn-cgi/l/email-protection#3c715958555f5d4e596c54454f555f555d527a59596f5f5459584950597c5f514f1254544f125b534a"><span class="__cf_email__" data-cfemail="fbb69e9f92989a899eab9382889298929a95bd9e9ea898939e9f8e979ebb989688d5939388d59c948d">[email protected]</span></a>, for
issues related to outpatient therapy services and KX modifier
thresholds.
Zehra Hussain, or <a href="/cdn-cgi/l/email-protection#e9a48c8d808a889b8cb981909a808a808887af8c8cba8a818c8d9c858ca98a849ac781819ac78e869f"><span class="__cf_email__" data-cfemail="531e36373a30322136033b2a203a303a323d15363600303b3637263f3613303e207d3b3b207d343c25">[email protected]</span></a>, for
issues related to payment of skin substitutes.
Rebecca Ray, or <a href="/cdn-cgi/l/email-protection#83f0e6e0b0b3b0e2f0f3e7e2f7e2c3e0eef0adebebf0ade4ecf5"><span class="__cf_email__" data-cfemail="8bf8eee8b8bbb8eaf8fbefeaffeacbe8e6f8a5e3e3f8a5ece4fd">[email protected]</span></a>, for issues related to
ASP reasonable assumptions.
Allison Cipro, (667) 414-0758, for issues related to Medicare
Diabetes Prevention Program.
Sabrina Ahmed, (410) 786-7499, or <a href="/cdn-cgi/l/email-protection#9bc8f3fae9feffc8faedf2f5fce8cbe9f4fce9faf6dbf8f6e8b5f3f3e8b5fcf4ed"><span class="__cf_email__" data-cfemail="d281bab3a0b7b681b3a4bbbcb5a182a0bdb5a0b3bf92b1bfa1fcbabaa1fcb5bda4">[email protected]</span></a>,
for issues related to the Medicare Shared Savings Program (Shared
Savings Program) quality performance standard and other quality
reporting requirements.
Janae James, (410) 786-0801, or <a href="/cdn-cgi/l/email-protection#6e3d060f1c0b0a3d0f180700091d3e1c01091c0f032e0d031d4006061d40090118"><span class="__cf_email__" data-cfemail="2f7c474e5d4a4b7c4e594641485c7f5d40485d4e426f4c425c0147475c01484059">[email protected]</span></a>,
for issues related to Shared Savings Program beneficiary assignment and
benchmarking methodology and shared losses mitigation.
Kari Vandegrift, (410) 786-4008, or
<a href="/cdn-cgi/l/email-protection#92c1faf3e0f7f6c1f3e4fbfcf5e1c2e0fdf5e0f3ffd2f1ffe1bcfafae1bcf5fde4"><span class="__cf_email__" data-cfemail="491a21283b2c2d1a283f20272e3a193b262e3b2824092a243a6721213a672e263f">[email protected]</span></a>, for issues related to Shared Savings
Program participation options, and ACO participant and SNF affiliate
change of ownership requirements.
Elisabeth Daniel, (667) 290-8793, for issues related to the
Medicare Prescription Drug Inflation Rebate Program.
Benjamin Picillo or Genevieve Kehoe,
<a href="/cdn-cgi/l/email-protection#96d7fbf4e3faf7e2f9e4efc5e6f3f5fff7fae2efdbf9f2f3fad6f5fbe5b8fefee5b8f1f9e0"><span class="__cf_email__" data-cfemail="53123e31263f32273c212a002336303a323f272a1e3c37363f13303e207d3b3b207d343c25">[email protected]</span></a>, or 1-844-711-2664 (Option 4) for
issues related to the Ambulatory Specialty Model.
Kati Moore, (410) 786-5471, for inquiries related to the Merit-
based Incentive Payment System (MIPS) track of the Quality Payment
Program (QPP).
Trevey Davis, (410) 786-6600, for inquiries related to the Advanced
Alternative Payment Models (APMs) track of QPP.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2025-19787 of November 5, 2025 (90 FR 49266), the final
rule entitled ``Medicare and Medicaid Programs; CY 2026 Payment
Policies Under the Physician Fee Schedule and Other Changes to Part B
Payment and Coverage Policies; Medicare Shared Savings Program
Requirements; and Medicare Prescription Drug Inflation Rebate Program''
(hereinafter referred to as the CY 2026 PFS final rule), there were
typographical and technical errors that are identified in this
correcting document.
The provisions of this correcting amendment are effective January
1, 2026.
II. Summary of Errors
A. Summary of Errors in the Preamble
On pages 49306, 49347, and 49385, we inadvertently made
typographical and technical errors.
On page 49540, we inadvertently made technical errors.
On pages 49563 and 49564, we inadvertently made errors in
describing a finalized provision.
On page 49567, we inadvertently made typographical errors and
omitted a summary of a finalized provision.
On page 49569, we inadvertently omitted text.
On page 49571, we inadvertently made a typographical error.
On page 49572, we inadvertently used incorrect wording in
describing participation.
On page 49575, we inadvertently excluded a definition.
On page 49576, we inadvertently excluded a reference and made two
typographical errors.
On page 49578, we inadvertently included duplicative language,
included
[[Page 12072]]
incorrect terminology, and made a grammatical error.
On page 49579, we inadvertently made a typographical error and
omitted clarifying language.
On page 49580, we inadvertently included duplicative language and
made typographical errors.
On page 49581, we inadvertently included duplicative language,
omitted clarifying language, and made typographical and technical
errors.
On page 49582, we inadvertently omitted clarifying language.
On page 49584, we inadvertently included duplicative text and made
a typographical error.
On pages 49585 through 49589, we made inadvertent typographical and
technical errors.
On page 49592, we inadvertently made an error in a section
reference.
On pages 49598 through 49600, we made inadvertent typographical and
technical errors.
On pages 49601, 49605, 49608, and 49613, we inadvertently omitted
language and made technical errors.
On pages 49616, 49619, and 49620, we made inadvertent errors in
section references.
On pages 49625 and 49629, we inadvertently omitted language.
On pages 49633, 49640, 49642, 49645, 49665, 49667, and 49669, we
made inadvertent typographical errors.
On page 49671, we inadvertently omitted clarifying language and
made typographical errors.
On pages 49672, 49675, 49679, 49680, 49683, 49684, and 49685, we
made inadvertent typographical and technical errors.
On page 49687, we inadvertently omitted language and made a
typographical error.
On page 49690, we made inadvertent errors in section references.
On page 49691, we inadvertently omitted language.
On page 49694, we made an inadvertent error in a section reference.
On page 49695, 49696, 49697, and 49699, we inadvertently made an
error in describing a finalized provision.
On page 49716, 49717, and 49719, we made inadvertent typographical
errors.
On page 49738, we inadvertently made a typographical error in a
reference.
On page 49744, we inadvertently made a technical error to a
footnote citation link.
On pages 49781, 49786, 49811, 49813, 49814, and 50002, we
inadvertently made typographical errors relating to the Shared Savings
Program.
On page 49841, we inadvertently omitted references to the QP
patient count threshold and QP payment amount threshold definitional
terms.
On pages 49851, 49852, 49853, and 49854 we inadvertently included a
former measure title for Quality #: 001.
On page 49927, we inadvertently omitted a cross reference.
On page 49928, we inadvertently omitted several regulatory
references related to QP determinations reflecting the finalized
policy.
On pages 49931, 49970, and 49971, we made inadvertent errors in
section references.
On page 49973, we made an inadvertent typographical error.
On pages 49994 and 50002, we made inadvertent errors in section
references and typographical errors.
On page 50004, we inadvertently made typographical errors in table
references.
B. Summary of Errors in the Appendices
On pages 50379, 50437, and 50445, we made typographical errors in
three tables in the appendices.
C. Summary and Correction of Errors in the Addenda on the CMS Website
At the time of publication of the CY 2026 PFS final rule, we
utilized the proposed Ambulatory Payment Classifications (APC) payment
amounts and Geometric Mean Costs (GMCs) from the Medicare Program;
Hospital Outpatient Prospective Payment and Ambulatory Surgical Center
Payment Systems; Quality Reporting Programs; Overall Hospital Quality
Star Rating; Hospital Price Transparency; and Notice of Closure of a
Teaching Hospital and Opportunity To Apply for Available Slots proposed
rule (90 FR 53448) (hereinafter referred to as the CY 2026 OPPS final
rule) for our PE RVU calculations of CPT codes 77402, 77407, 77412,
77436, 77437, 77438, 99445, 99454, 98977 and 98985 because that was the
most recent information available. With the publication of the CY 2026
OPPS final rule, we are updating the PE RVUs for 77402, 77407, 77412,
77436, 77437, 77438, 99445, 99454, 98977, and 98985 based on the final
OPPS APC payment rates and GMCs with this correction notice, as
displayed in Addendum B. We are also updating the Proxy Inputs for
Radiation Services public use file available under the Downloads posted
with this correction notice to reflect these changes. As a result of
the PE RVU changes for CPT codes77402, 77407, 77412, 77436, 77437,
77438, 99445, 99454, 98977 and 98985, all PFS PE RVUs were
recalculated, and some codes on the PFS will receive slightly different
PE RVUs as a result of PE RVU budget neutrality. These changes are
reflected in the updated Addendum B file.
Additionally, we note that at the time of the CY 2026 PFS final
rule, the Addendum B listed the incorrect payment for the following
skin substitute codes: HCPCS codes A2025, A2029, A2031, A2032, A2034,
A2036, A2038, A2039, and A4100. These skin substitute codes were
changed to receive active pricing (Procedure Status ``A'') with a Non-
Facility PE RVU and Total Non-Facility RVU of 3.81 to align with our
policy and that change is listed in the updated Addendum B file
displayed online. Additionally, skin substitute codes Q4106 and Q4226
were both removed from Addendum B. We also note that HCPCS codes Q4398-
Q4420, Q4431, Q4432, and Q4433 were omitted from Addendum B due to
their incorrect Procedure Status ``E.'' The HCPCS codes' Procedure
Status has been updated to Procedure Status ``C'' and the global
periods for skin substitute HCPCS codes Q4431, Q4432, and Q4433 will be
corrected to ZZZ in the updated Addendum B file. Additionally, HCPCS
codes Q4224 was omitted from Addendum B due to its incorrect Procedure
Status ``E.'' The HCPCS code's Procedure Status has been updated to
Procedure Status ``A'' with a Non-Facility PE RVU and Total Non-
Facility RVU of 3.81. We have made these updates to Addendum B file to
align with the correct classification of skin substitute codes
displayed online in the public use files. These changes include
updating the Addendum B file to reflect that skin substitute HCPCS
codes Q4398 through Q4420 receive active pricing. We also updated the
Addendum B file to reflect HCPCS codes Q4431, Q4432, and Q4433 to
receive contractor pricing.
D. Summary of Errors in the Amendatory Instructions
On pages 50007, 50008, 50009, 50010, 50014, 50021 we inadvertently
made typographical errors in the amendatory instructions for Sec. Sec.
410.15, 410.62, 410.79, 414.84, 414.1305, and 424.205.
E. Summary of Errors in the Regulations Text
On page 50006, we made typographical errors in the regulation text
for Sec. 405.2463 by noting ``On or after October 1, 2025'' instead of
``Not before October 1, 2025''.
On page 50007, we inadvertently made technical errors in the
regulation text for Sec. 410.26, by failing to remove the references
to paragraphs (a)(2)(i) and (ii).
[[Page 12073]]
On pages 50007, 50008, and 50009, we inadvertently made
typographical errors in the amendatory instructions for Sec. Sec.
410.79 and 414.84, which caused regulation text to be removed.
On page 50009, in Sec. 414.1305, we made technical errors in the
definitions of: ``Attribution-eligible beneficiary'', ``Covered
professional service attribution-eligible beneficiary'' introductory
text, and ``E/M attribution-eligible beneficiary''. We also
inadvertently omitted amendatory instructions to revise the definitions
of ``QP patient count threshold'' and ``QP payment amount threshold''.
On pages 50010 and 50011 in Sec. 414.1380, there were technical
errors in the implementation of the revisions in the Code of Federal
Regulations (CFR) for paragraphs (b)(2)(iii) and (vi). Specifically,
the finalized changes to paragraphs (b)(2)(iii) and (vi) were
inadvertently made in the CFR to paragraphs (b)(1)(iii) and (vi).
On pages 50013 and 50014 in Sec. 414.1435, we made technical
errors in the structuring of paragraphs and inadvertently omitted
finalized language for Sec. 414.1435(h).
On page 50016 in Sec. 425.512, there were technical errors in the
implementation of the finalized revisions to paragraphs (c)(3)(ii)
through (iv) in the CFR. Specifically, revisions to remove the phrase
``health equity adjusted quality performance score'' and add the phrase
``quality score'' to paragraphs (c)(3)(ii) through (iv) were
incorrectly implemented in the CFR.
On page 50021, we inadvertently indicated that revisions were being
made to regulatory language at Sec. 427.502(c)(1)(ii), which in fact
were made to Sec. 427.502(c)(2)(ii). In addition, there were technical
errors in the revised language adopted at Sec. Sec. 427.502(c)(1)(ii)
and (c)(2)(ii) and 428.402(c)(1)(ii) and (c)(2)(ii). When revising the
language in Sec. 428.402(c)(2)(ii), we inadvertently failed to correct
a typographical error in a reference in language adopted in the final
rule that appeared in the December 9, 2024 Federal Register titled
``Medicare and Medicaid Programs; CY 2025 Payment Policies Under the
Physician Fee Schedule and Other Changes to Part B Payment and Coverage
Policies; Medicare Shared Savings Program Requirements; and Medicare
Prescription Drug Inflation Rebate Program; and Medicare
Overpayments''. Section 428.402(c)(2)(ii), as amended in the CY 2026
PFS final rule, referred erroneously to a Rebate Report ``specified in
paragraph (b)(2),'' which paragraph does not exist, rather than such a
Report ``specified in paragraph (c)(2),'' as intended. The corrected
text amends the reference to ensure the regulatory text accurately
reflects the policy as proposed and adopted in the CY 2026 PFS final
rule.
On pages 50022 through 50035, we inadvertently omitted undesignated
headings in part 512, subpart G.
On page 50022 in Sec. 512.705, we inadvertently omitted language
in the definition of ``ASM payment year''.
On page 50025 in Sec. 512.710(f)(1), we inadvertently made a
typographical error in a reference.
On page 50026 in Sec. 512.710(g)(1)(ii), we inadvertently made a
typographical error.
On page 50027 in Sec. 512.725(b)(1), we inadvertently omitted
language text in detailing the MIPS Q492 measure.
On page 50028, we inadvertently made a typographical error in the
regulations text at Sec. 512.730(e)(1).
On page 50031 in Sec. Sec. 512.745(a)(3)(i) and (a)(4)(i) and
512.750(c)(1)(i), we inadvertently made typographical and technical
errors.
On page 50032 in Sec. 512.750(f)(2), we inadvertently made a
technical error.
On page 50035 in Sec. 512.775, we inadvertently made referencing
errors.
III. Waiver of Proposed Rulemaking and Delay in Effective Date
Section 1871(b)(1) of the Social Security Act (the Act) requires
the Secretary to provide for notice of a proposed rule in the Federal
Register and provide a period of not less than 60 days for public
comment. In addition, section 1871(e)(1)(B)(i) of the Act mandates a
30-day delay in effective date after issuance or publication of
substantive changes as specified. Section 1871(b)(2)(C) of the Act
provides an exception from the notice and 60-day comment period and
delay in effective date requirements of the Act, under the standards
set forth in 5 U.S.C. 553(b). Section 1871(e)(1)(B)(ii) of the Act
provides an exception from the delay in effective date requirements of
the Act as well. Section 553(b)(B) authorizes an agency to dispense
with normal notice and comment rulemaking procedures for good cause if
the agency makes a finding that the notice and comment process is
impracticable, unnecessary, or contrary to the public interest, and
includes a statement of the finding and the reasons for it in the rule.
Similarly, section 1871(e)(1)(B)(ii) of the Act allows an exception to
the effective date where the Secretary finds that waiver is necessary
to comply with statutory requirements, or that the delay is contrary to
the public interest and the agency includes in the rule a statement of
the finding and the reasons for it.
In our view, this correcting document does not constitute a
rulemaking that would be subject to these requirements. This document
corrects technical errors in the CY 2026 PFS final rule. The
corrections contained in this document are consistent with, and do not
make substantive changes to, the policies and payment methodologies
that were proposed, subject to notice and comment procedures, and
adopted in the CY 2026 PFS final rule. As a result, the corrections
made through this correcting document are intended to resolve
inadvertent errors so that the rule accurately reflects the policies
adopted in the final rule. Even if the notice and comment and delayed
effective date requirements applied, we find that there is good cause
to waive such requirements. Undertaking further notice and comment
procedures to incorporate the corrections in this document into the CY
2026 PFS final rule or delaying the effective date of the corrections
would be contrary to the public interest because it is in the public
interest to ensure that the rule accurately reflects our policies as of
the date they take effect. Further, such procedures would be
unnecessary because we are not making any substantive revisions to the
final rule, but rather, we are simply correcting the Federal Register
document to reflect the policies that we previously proposed, received
public comment on, and subsequently finalized in the final rule. For
these reasons, we find good cause to waive notice and comment and not
delay the effective date, in the event they are deemed required.
IV. Correction of Errors
In FR Doc. 2025-19787 of November 5, 2025 (90 FR 49266), make the
following corrections:
A. Correction of Errors in the Preamble
1. On page 49306, first column, first partial paragraph, line 1,
the phrase ``CPT codes 96920, 92921, and 96922'' is corrected to read
``CPT codes 96920, 96921, and 96922''.
2. On page 49347, second column, first partial paragraph, line 48,
the reference, ``77X09'' is corrected to read ``77439''.
3. On page 49385, second column, fifth paragraph, line 25, the
figure ``55 percent'' is corrected to read ``60 percent''.
4. On page 49540, first column, third full paragraph, lines 6
through 8, the phrase ``assumptions, and if any concerns are
identified, we will reach out to the manufacturer.'' is corrected to
[[Page 12074]]
read ``assumptions, and if any concerns are identified, we may reach
out to the manufacturer.''.
5. On page 49563,
a. Second column, first full paragraph, lines 5 through 11, the
phrase ``By evaluating clinicians individually, ASM removes the unequal
reporting and scoring benefits that have been previously afforded to
consolidated health systems and group practices. This form of mandatory
participation'' is corrected to ``ASM removes the unequal reporting and
scoring benefits that have been previously afforded to consolidated
health systems and group practices while allowing reporting
flexibilities for ASM participants in small practices to mitigate
reporting burden. Mandatory participation of individual clinicians''.
b. Third column, last partial paragraph, lines 6 through 10, and
continuing on page 49564, first partial paragraph, lines 1 through 5,
the phrase ``ASM aims to assess the quality and cost performance of ASM
participants providing care for Medicare beneficiaries with the
targeted chronic conditions at the individual clinician level (TIN/NPI)
while measuring practice transformation and interoperability
strengthening at the group level. Specifically, ASM will test'' is
corrected to read ``ASM aims to assess the quality performance of the
majority of ASM participants at the individual clinician level (TIN/
NPI), the cost performance of all ASM participants at the individual
clinician (TIN/NPI level), and practice transformation and
interoperability strengthening at the group (TIN) level. We note that
we will allow ASM participants to report quality measures at the group
(TIN) level to mitigate reporting burden as discussed in section
III.C.2.d.(1).(b). of this final rule. ASM will test''.
6. On page 49567,
a. Second column, fourth full paragraph, line 3, the word ``ASMs''
is corrected to ``ASM''.
b. Third column, second full paragraph, lines 10 through 25, the
phrase ``For these reasons, ASM will include specific positive scoring
adjustments for ASM participants who we determine have a high degree of
medically or socially complex patients, as well as scoring adjustments
for participants in small practices or who are solo practitioners. We
note that eligibility for these scoring adjustments will be evaluated
separately, so ASM participants can qualify for both the complex
patient scoring adjustment and small practice scoring adjustment. We
refer readers to sections III.C.2.e.(3) and III.C.2.e.(4) of this final
rule for further discussion on these provisions.'' is corrected to read
``For these reasons, ASM will include specific positive scoring
adjustments for ASM participants who we determine have a high degree of
medically or socially complex patients. Further, ASM participants who
are solo practitioners or in a small practice will receive positive
scoring adjustments on their final score and may submit quality measure
data at the group (TIN) level to reduce burden. We note that
eligibility for these scoring adjustments will be evaluated separately,
so ASM participants can qualify for both the complex patient scoring
adjustment and small practice scoring adjustment. We refer readers to
sections III.C.2.d.(1).(b)., III.C.2.e.(3). and III.C.2.e.(4). of this
final rule for further discussion on these provisions.''.
7. On page 49569, second column, second full paragraph, line 17,
the phrase ``Part B payments'' is corrected to ``Part B payments for
covered professional services''.
8. On page 49571, third column, first full paragraph, line 8, the
phrase ``they would subject'' is corrected to read ``they would be
subject''.
9. On page 49572, first column, first partial paragraph, last line,
the phrase ``participating in'' is corrected to ``reporting under''.
10. On page 49575,
a. First column, third full paragraph,
(1) Lines 2 and 3, the phrase ``proposed `ASM participant'
definition'' is corrected to read ``proposed `ASM participant' and `ASM
low back pain participant' definitions''.
(2) Line 11, the phrase ``the `ASM participant' definition'' is
corrected to read ``the definitions''.
11. On page 49576,
a. First column, first full paragraph, line 21, the phrase
``comment rulemaking.'' is corrected to read ``comment rulemaking. We
note that we have finalized a provision for ASM participants in small
practices to report quality measure data at the group (TIN) level,
which we discuss in section III.C.2.d.(1).(b). of this final rule.''.
b. Third column,
(1) Fourth full paragraph, line 34, the phrase ``CMS to
reconsider'' is corrected to read ``CMS reconsider''.
(2) Fifth full paragraph, line 7, the phrase ``comparing to'' is
corrected to read ``comparing''.
12. On page 49578, second column,
a. Second full paragraph, lines 2 through 4, ``proposed ASM low
back pain participant and ASM low back pain cohort definitions.'' is
corrected to read ``proposed `ASM low back pain cohort' definition.''.
b. Third full paragraph, line 3, ``participant'' is corrected to
read ``cohort''.
13. On page 49579,
a. First column,
(1) First full paragraph, lines 2 and 3, the phrase ``define ASM
low back pain participant and the ASM low'' is corrected to read
``define the ASM low''.
(2) Second full paragraph, lines 2 and 3, the phrase ``define ASM
low back pain participant and ASM low'' is corrected to read ``define
the ASM low''.
b. Second column, first full paragraph,
(1) Line 3, the phrase ``low back pain cohort.'' is corrected to
read ``low back pain cohort, including those who oversee non-procedural
interventions.''.
(2) Line 36, the phrase ``suggested CMS to'' is corrected to read
``suggested that CMS''.
14. On page 49580, first column,
a. First full paragraph,
(1) Line 15, the word ``anesthesiologists'' is corrected to read
``anesthesiology''.
(2) Line 25, the word ``provided'' is corrected to read
``providing''.
b. Second full paragraph, line 7, the word ``patient's'' is
deleted.
c. Fourth full paragraph, lines 2 through 4, ``finalizing the `ASM
low back pain participant' and `ASM low back pain cohort' definitions''
is corrected to read ``finalizing the `ASM low back pain cohort'
definition''.
15. On page 49581,
a. First column,
(1) First full paragraph, line 4, the phrase ``response We did
not'' is corrected to read ``response. We did not''.
(2) Last paragraph, line 11, the phrase ``identifiable by their
unique NPI. We'' is corrected to read ``identifiable by their unique
NPI.''.
b. Second column,
(1) First partial paragraph, lines 1 through 9, the phrase ``stated
that when TIN and NPI are used together, CMS is able to identify and
evaluate individual providers. NPI-level participation also aligns with
the Innovation Center's goal of creating a level playing field for all
clinicians and removing unequal benefits afforded to consolidated group
practices and health systems.'' is corrected by removing the phrase.
(2) Second full paragraph, lines 23 through 28, the phrase ``This
approach would maintain consistency between participant identification
and performance assessment within ASM and mirrors the methodology used
in the Quality Payment Program.'' is corrected by removing the phrase.
(3) Third full paragraph, lines 5 through 9, the phrase
``Identifying ASM
[[Page 12075]]
participants at the TIN/NPI level will allow for like-to-like
performance assessment of clinicians who meet ASM participant
eligibility criteria.'' is corrected to read ``The ASM participation
identification approach supports the goals of increasing clinician-
level accountability for quality and cost performance. While we will
allow ASM participants in small practices to report required quality
measures at the group (TIN) level to address concerns of reporting
burden for this type of ASM participant, TIN/NPI-level quality
assessment for all other ASM participants and TIN/NPI-level cost
performance assessment for all participants will allow for more like-
to-like comparison of clinicians who meet ASM participant eligibility
criteria.''
16. On page 49582, first column, second full paragraph, line 10,
the phrase ``participation in ASM.'' is corrected to read
``participation in ASM. We also note that we did not consider allowing
a clinician to choose under which TIN/NPI they would be an ASM
participant. Rather, we considered selecting the TIN/NPI combination
with the most EBCM-triggered episodes in the case that a clinician
meets ASM participant eligibility criteria under more than one TIN/NPI
combination.''.
17. On page 49584,
a. First column, second full paragraph, lines 18 through 23, the
phrase ``eligibility criteria. Because using the majority would require
that a single specialty code be applied to more than half of all
Medicare Part B claims, a clinician changing their specialty midyear
may not meet this threshold. Using'' is corrected to read ``eligibility
criteria. Using''.
b. Third column, first full paragraph, line 4, the phrase the
``participant.; the commenters believed'' is corrected to read
``participant; the commenters believed''.
18. On page 49585, first column, first full paragraph, line 2, the
phrase ``CMS to consider supplementing'' is corrected to read ``CMS
consider supplementing''.
19. On page 49586, third column,
a. Second full paragraph, line 8, the phrase ``use low back pain
EBCM'' is corrected to read ``use the low back pain EBCM''.
b. Third full paragraph, line 5, the phrase ``promotes consistency
between MIPS'' is corrected to read ``promotes consistency with MIPS''.
20. On page 49587, second column, last full paragraph, line 3 and
4, the phrase ``episodes for EBCM to'' is corrected to read ``episodes
to''.
21. On page 49588, third column, first full paragraph, line 6, the
word ``conditions'' is corrected to read ``condition''.
22. On page 49589, second column, second full paragraph, line 4,
the phrase ``we proposed that IP Codes'' is corrected to read ``we
proposed that ZIP codes''.
23. On page 49592, second column, second full paragraph, line 23,
the reference ``section VII'' is corrected to read ``section VI''.
24. On page 49598,
a. First column, first partial paragraph, line 6, the phrase
``ASM's performance'' is corrected to read ``ASM participant's
performance''.
b. Second column, first partial paragraph, line 9, the phrase
``ASM's performance'' is corrected to read ``ASM participant's
performance''.
25. On page 49599, second column, first full paragraph, line 7, the
phrase ``specialty'' is corrected to read ``specialists''.
26. On page 49600, first column,
a. First full paragraph, lines 23 through 28, the sentence ``We
have determined that allowing multiple reporting configurations would
undermine ASM's design objective of creating clear peer-to-peer
performance comparisons for determining payment adjustments.'' is
corrected to read ``We have determined that allowing multiple reporting
configurations could undermine ASM's design objective of creating clear
peer-to-peer performance comparisons for determining payment
adjustments.''.
b. Second full paragraph, line 10, the phrase ``believe that it
is'' is corrected to read ``believed that it was''.
27. On page 49601,
a. First column, first full paragraph, line 33, the phrase ``the
TIN-level.'' is corrected to read ``the TIN-level. We believe this
flexibility is appropriate because in a small practice each clinicians'
relative contribution to an individual quality measure's performance is
larger, meaning there is increased accountability on each clinician for
their performance even though the quality measure reflects a group's
performance.''
b. Second column, fifth full paragraph, lines 7 through 11, the
sentence ``Based on the data submission provisions we are finalizing in
this final rule, we note that ASM participants will not have the
flexibility to report both as an individual and as a group.'' is
corrected to read ``Based on the data submission provisions we are
finalizing in this final rule, we note that ASM participants must
report quality measure data at the individual clinician (TIN/NPI) level
unless they are in a small practice; ASM participants in small
practices may report quality measure data at the group (TIN) level. All
ASM participants must report improvement activities and Promoting
Interoperability at the group (TIN) level.''.
28. On page 49605, third column, first partial paragraph,
a. Line 37, the word ``incentivizing'' is corrected to read
``incentivizes''.
b. Lines 38 and 39, the phrase ``experience could drive
improvements'' is corrected to ``experience, which could drive
improvements''.
29. On page 49608, second column, first full paragraph, line 6 and
7, the phrase ``measure in the heart failure quality measure set'' is
corrected to read ``measure, with minor modification, in the heart
failure quality measure set''.
30. On page 49613, second column, second full paragraph, lines 1
and 2, the sentence ``We also received broad feedback on the heart
failure quality measure set.'' is corrected to read ``After reviewing
public comments, we are finalizing the inclusion of Functional Status
Assessments for Heart Failure (MIPS Q377) as proposed at Sec.
512.725(b)(5). We intend to consider re-specification of this measure
into a PRO-PM through future notice-and-comment rulemaking. We also
received broad feedback on the heart failure quality measure set.''.
31. On page 49616, first column, first partial paragraph, lines 24
through 32, the sentences ``After reviewing public comments, we are
finalizing the inclusion of Functional Status Assessments for Heart
Failure (MIPS Q377) as proposed at Sec. 512.725(b)(5). We intend to
consider re-specification of this measure into a PRO-PM through future
notice-and-comment rulemaking.'' is corrected to read ``After reviewing
public comments, we are finalizing the quality measure set for the
heart failure cohort as proposed at Sec. 512.725(b).''.
32. On page 49619, second column, first full paragraph, line 10,
the citation ``(90 FR 32589 through 32594)'' is corrected to read ``(90
FR 32581)''.
33. On page 49620, first column, second full paragraph, lines 8 and
9, the citation ``(90 FR 32589 through 32594)'' is corrected to read
``(90 FR 32581)''.
34. On page 49625, first column, third full paragraph, lines 2
through 7, the phrase ``we are finalizing the inclusion of the (MIPS
Q220) Functional Status Change for Patients with Low Back Impairments
in the low back pain quality measure set as proposed at Sec.
512.725(c)(4).'' is corrected to read ``we are finalizing the quality
measure set for the ASM low back pain cohort, with modification, at
Sec. 512.725(c).''.
[[Page 12076]]
35. On page 49629, second column, third full paragraph, lines 10
through 11, the phrase ``incorporated into the quality measure sets
accordingly'' is corrected to read ``incorporated into the quality
measure sets accordingly, except as noted for MIPS Q492, with
modification.''
36. On page 49633, third column, first full paragraph, line 34, the
phrase ``case minimum of this proposed rule'' is corrected to read
``case minimum of this final rule''.
37. On page 49640, first column, first full paragraph,
a. Line 26, the phrase ``opportunities for findings savings'' is
corrected to ``opportunities for finding savings''.
b. Line 28, the phrase ``extensive with interested parties input,
including specialty societies'' is corrected to read ``extensive review
including with specialty societies''.
38. On page 49642,
a. First column, first partial paragraph, line 16, the phrase
``extensive interested parties'' is corrected to read ``extensive
review from interested parties''.
b. Second column,
(1) First partial paragraph, line 3, the phrase ``relationship
that'' is corrected to read ``relationship exists''.
(2) Second full paragraph,
(a) Line 7, the phrase ``triggered. And'' is corrected to read
``triggered, and''.
(b) Line 8, the phrase ``attributable to a TIN or TIN/NPI The'' is
corrected to read ``attributable to a TIN or TIN/NPI. The''.
(3) Fourth paragraph, line 10, the phrase ``20-episodethreshold''
is corrected to read ``20-episode threshold''.
39. On page 49645,
a. First column, first partial paragraph, line 2, word ``believe''
is corrected to read ``believed''.
b. Second column, second full paragraph, line 21, the phrase
``include'' is corrected to read ``while including''.
40. On page 49665, lower three-fourths of the page, third column,
first partial paragraph, line 31, the phrase ``of this proposed rule''
is corrected to ``of this final rule''.
41. On page 49667, second column, second full paragraph, line 11,
the word ``incentive'' is corrected to read ``incentivize''.
42. On page 49669, third column, first partial paragraph, line 6,
the word ``reweighing'' is corrected to read ``reweighting''.
43. On page 49671, first column, last partial paragraph, lines 1
through 3, through the second column, first paragraph, lines 1 through
10, the phrase ``We considered, but did not propose, adopting an
approach in which quality performance is risk adjusted for complex
patients. We believe that providers have substantial control over the
health care encounter and the outcomes assessed after the encounter.
Thus, we decided that adjustments made at the quality measure or
quality ASM performance category level would undermine our core aim to
promote direct accountability and high-quality outcomes for all
beneficiaries.'' is corrected to read ``We considered, but did not
propose, adopting an approach in which the quality ASM performance
category is risk adjusted for complex patients. We believe that
providers have substantial control over the health care encounter and
the outcomes assessed after the encounter. Thus, we decided that
adjustments made at quality ASM performance category level would
undermine our core aim to promote direct accountability and high-
quality outcomes for all beneficiaries. We note that we will maintain
any risk adjustment in required quality measures whose specifications
include risk adjustment.''.
44. On page 49672, first column, first partial paragraph, line 5,
the phrase ``using data from data from the'' is corrected to read
``using data from the''.
45. On page 49675, first column, third full paragraph, line 15, the
phrase ``of this proposed rule'' is corrected to read ``of this final
rule''.
46. On page 49679,
a. Second column, second full paragraph,
(1) Line 12, the phrase ``ASM payment year.'' is corrected to read
``ASM payment year (90 FR 32605).''
(2) Line 22, the phrase ``an ASM payment year.'' is corrected to
read ``an ASM payment year (90 FR 32605).''
b. Third column,
(1) First partial paragraph, line 11, the phrase ``of this proposed
rule'' is corrected to read ``of this final rule''.
(2) First full paragraph, line 2, the phrase ``2026 PFS proposed
rule'' is corrected to read ``2026 PFS proposed rule (90 FR 32605)''.
(3) Second full paragraph, lines 1 and 2, the phrase ``The proposed
payment methodology is'' is corrected to read ``In the CY2026 PFS
proposed rule (90 FR 32605), we proposed a payment methodology''.
47. On page 49680,
a. First column, last partial paragraph, line 2, the word
``differs'' is corrected to read ``differed''.
b. Second column, first partial paragraph, lines 10 and 11, the
phrase ``As discussed earlier and later in this section'' is corrected
to read ``As discussed in section III.C.2.f.(2).''.
48. On page 49683, second column, second full paragraph, line 6,
the phrase ``of this proposed rule'' is corrected to read ``of this
final rule''.
49. On page 49684, first column, second full paragraph, lines 19
through 21, the phrase ``same set of requirements reported at the same
TIN/NPI level (that is, the level at which an ASM participant is
identified)'' is corrected to read ``same set of requirements''.
50. On page 49685, first column, first partial paragraph, lines 21
thorough 25, the phrase ``We do not believe that allow this subset of
ASM participants to report data at the TIN level would not undermine
our performance comparison approach.'' is corrected to read ``We do not
believe that allowing this subset of ASM participants to report quality
measure data at the TIN level would undermine our performance
comparison approach.''.
51. On page 49687,
a. First column, first full paragraph, line 36, the phrase ``ASM we
would'' is corrected to read ``we would''.
b. Third column, fourth full paragraph, line 13, the phrase
``statistical variation'' is corrected to read ``undesirable
statistical variation''.
52. On page 49690,
a. Second column, first partial paragraph, line 23, the phrase
``section VII'' is corrected to read ``section VI.''.
b. Third column, first full paragraph, line 2, the phrase ``section
VII'' is corrected to read ``section VI.''.
53. On page 49691, first column, first full paragraph, line 29 and
30, the phrase ``Part B adjustments'' is corrected to read ``Part B
payment adjustments''.
54. On page 49694, lower two-thirds of the page, first column,
first full paragraph, line 14, the reference ``section VII'' is
corrected to read ``section VI.''.
55. On page 49695, second column, second paragraph, line 45, the
phrase ``advantage'' is corrected to read ``advantageous''.
56. On page 49696, second column, third full paragraph, lines 1 and
2, the phrase ``During an ASM payment year, we proposed at Sec.
512.750(f)(1) that'' is corrected to read ``In the CY 2026 PFS proposed
rule (90 FR 32614), we proposed at Sec. 512.750(f)(1) that during an
ASM payment year''.
57. On page 49697, top of page, second column, partial paragraph,
lines 1 and 2, the phrase ``on ASM payment adjustment multiplier.'' is
corrected to read ``one ASM payment multiplier.''.
58. On page 49699, first column, second full paragraph, lines 14
through 24, the phrase ``We note that we are not allowing ASM
participants choice in how they report data (that is, as an
[[Page 12077]]
individual and as a group) for a given ASM performance year, so there
is no need to develop rules for resolving such reporting conflicts. Our
finalized policies related to data submission at Sec. 512.720 also
describe how we will manage multiple data submissions from an
individual ASM participant.'' is corrected to read ``Beyond allowing
ASM participants in small practices to report group-level quality
measures discussed in section III.C.2.d.(1).(b) of this final rule, we
are not allowing most ASM participants choice in the level at which
they report quality, improvement activities, or Promoting
Interoperability data (that is, as an individual or as a group) for a
given ASM performance year. We intend to revisit these data submission
provisions in the CY 2027 rulemaking cycle to clarify how allowing ASM
participants in small practices to report group-level quality measures
data may influence data submission procedures, determination of ASM
performance category scores, and calculation of final scores.''
59. On page 49716, third column, second full paragraph, line 6, the
phrase ``eligibility criteria'' is corrected to read ``ASM participant
eligibility criteria''.
60. On page 49717, first column, second partial paragraph, line 4,
the phrase ``we would not preclude'' is corrected to read ``we will not
preclude''.
61. On page 49719,
a. Second column, second full paragraph, line 9, the word
``models'' is corrected to read ``model''.
b. Third column, second full paragraph, line 1, the phrase ``We
would also'' is corrected to ``We will also''.
62. On page 49738, first column, last partial paragraph, line 13,
the phrase ``As stated on page 98578 of the CY 2025 PFS final rule).''
is corrected to read ``As stated in the CY 2025 PFS final rule (89 FR
98264).''.
63. On page 49744, third column, first footnote paragraph (footnote
362), lines 6 and 7, the hyperlink ``<a href="https://edit.cms.gov/files/document/ipay-2028-final-guidance.pdf">https://edit.cms.gov/files/document/ipay-2028-final-guidance.pdf</a>''is corrected to read ``<a href="https://www.cms.gov/files/document/ipay-2028-final-guidance.pdf">https://www.cms.gov/files/document/ipay-2028-final-guidance.pdf</a>''.
64. On page 49781, second column, first full paragraph, line 8, the
phrase ``precent'' is corrected to read ``percent''.
65. On page 49786, first column, first full paragraph, lines 4 and
5, the phrase, ``that they have fewer than 5,000 beneficiaries'' is
corrected to read ``that have fewer than 5,000 beneficiaries''.
66. On page 49811, third column, third full paragraph, lines 1 and
2, the reference ``section III.F.8.(2)'' is corrected to read ``section
III.F.8.b.(2).''.
67. On page 49813, third column, last partial paragraph, line 4,
the phrase ``downside risks'' is corrected to read ``downside risk''.
68. On page 49814, first column, first partial paragraph, line 1,
the reference ``section III.F.2.(2)'' is corrected to read ``section
III.F.2.''.
69. On page 49841, second column, sixth and seventh bulleted
paragraphs, the bulleted paragraphs are corrected to read as follows:
``<bullet> MVP Participant
<bullet> QP patient count threshold
<bullet> QP payment amount threshold
<bullet> Single specialty group''.
70. On page, 49851, in the table titled Table C-BC1: APM
Performance Pathway Quality Measure Set Beginning with the CY 2026
Performance Period/2028 MIPS Payment Year, second column, second row,
the measure title ``Diabetes: Hemoglobin A1c (HbA1c) Poor Control'' is
corrected to read, ``Diabetes: Glycemic Status Assessment Greater Than
9%''.
71. On page 49852, in the table titled Table C-BC2: App Plus
Quality Measure Set for the CY 2026 Performance Period/2028 MIPS
Payment Year, second column, second row, the measure title ``Diabetes:
Hemoglobin A1c (HbA1c) Poor Control'' is corrected to read, ``Diabetes:
Glycemic Status Assessment Greater Than 9%''.
72. On page 49853, in the table titled Table C-BC3: App Plus
Quality Measure Set for the CY 2027 Performance Period/2029 MIPS
Payment Year, second column, second row, the measure title ``Diabetes:
Hemoglobin A1c (HbA1c) Poor Control'' is corrected to read, ``Diabetes:
Glycemic Status Assessment Greater Than 9%''.
73. On page 49854, lower three-fourths of the page, in the table
titled Table C-BC4: App Plus Quality Measure Set Beginning with the CY
2028 Performance Period/2030 MIPS and Subsequent Performance Periods/
MIPS Payment Years, second column, second row, the measure title
``Diabetes: Hemoglobin A1c (HbA1c) Poor Control'' is corrected to read,
``Diabetes: Glycemic Status Assessment Greater Than 9%''.
74. On page 49927, second column, first partial paragraph, line 20,
the placeholder reference ``XX.XX.x.(2).'' is corrected to read
``IV.5.b.(2).''.
75. On page 49928,
a. Second column, first partial paragraph, lines 58 through 68 and
continuing to the first partial sentence of the third column, beginning
with the phrase ``We further are finalizing'' and ending with the
phrase ``amendments to Sec. 414.1435'' is corrected to read ``We
further are finalizing amendments at Sec. 414.1305 to support and
clearly delineate these separate calculations by: (1) revising the
definition of ``attribution-eligible beneficiary'' to sunset with the
2025 QP Performance Period; (2) adding new definitions for ``Covered
professional service attribution-eligible beneficiary'' and ``E/M
attribution-eligible beneficiary'' effective with the 2026 QP
Performance Period; and (3) making conforming revisions to the
definitions of ``QP payment amount method'' and ``QP patient count
method''.
b. Third column, first partial paragraph, lines 11 and 12, the
phrase ``(payment and patient count).'' is corrected to read ``(payment
and patient count). Because the policy we are finalizing results in the
use of two sets of payment amount and patient count calculations--one
using E/M and another using Covered Professional Services--these
amendments are needed to fully effectuate the final policy. We note
that these changes were not necessary under the proposed policy because
that policy maintained the use of a single set of payment amount and
patient count calculations. Additionally, we are finalizing revisions
to Sec. 414.1435(a) and (b) to sunset the original payment amount and
patient count methodologies after the 2025 QP Performance Period, and
we are redesignating Sec. 414.1435(c) and (d) to (g) and (h),
respectively. Together, these amendments serve to effectuate the use of
both E/M-based calculations as well as Covered Professional Services-
based calculations for all eligible clinicians in Advanced APMs.
Finally, we are finalizing conforming revisions to the use of
methods regulation at the redesignated Sec. 414.1435(h) to provide
that through 2025, both the payment amount and patient count methods
described in paragraphs (a) and (b) are used to determine QP status,
and that, starting with 2026, all of the methods described in
paragraphs (c) through (f) will be used to determine QP status for each
QP Performance Period. These revisions will maintain our existing
practice of using the highest score in assigning a status of QP,
Partial QP, or neither.''
76. On page 49931, first column, first full paragraph, line 23, the
reference ``section VII.I.5.'' is corrected to read ``section
VI.F.4.''.
77. On page 49970, third column, first partial paragraph, line 4,
the reference ``section VI.E.7.b.(1).'' is corrected to read ``section
VI.F.4.b''.
78. On page 49971,
a. Second column, fourth full paragraph, line 1, the reference
``section
[[Page 12078]]
VI.H'' is corrected to read ``section VI.B.''.
b. Third column, second full paragraph, line 1, the reference
``section VI.E.b.(1).'' is corrected to read ``section VI.F.4.b.''.
79. On page 49973, third column, first partial paragraph, line 6,
the phrase ``which will would range'' is corrected to read ``which will
range''.
80. On page 49994, first column, fourth full paragraph,
a. Line 1, the reference ``section III.D.'' is corrected to read
``section III.C.''.
b. Line 11, the reference ``section III.D.'' is corrected to
``section III.C.''.
81. On page 50002,
a. First column, last partial paragraph
(1) Line 1, the reference ``section III.D.'' is corrected to read
``section III.C.''.
(2) Line 3, the phrase ``ASM. As proposed, we would test'' is
corrected to read ``ASM. We will test''.
b. Third column, first full paragraph, line 23, the phrase
``patients'' is corrected to read ``patient''.
82. On page 50004, lower half of the page, third column, last full
paragraph, lines 3 and 4, the references ``Tables 113 through 115'' are
corrected to read ``Tables D-B28 through D-B30''.
B. Correction of Errors in the Appendices
83. On page 50379, top of the page, in the table titled ``Table A.1
Diagnostic Radiology MVP Clinical Groupings'', third row (Q494:
Excessive Radiation Dose or Inadequate Image Quality for Diagnostic
Computed Tomography (CT) in Adults (Clinician Level) (Collection Type:
eCQM)),
a. Third column (Outcome), the entry ``No'' is corrected to read
``Yes''.
b. Fourth column (High Priority), the entry ``No'' is corrected to
read ``Yes''.
84. On page 50437, middle of the page, in the table titled ``Table
B.11 Optimal Care for Kidney Health MVP Clinical Groupings'', sixth row
(Q511: Percentage of Prevalent Patients Waitlisted (PPPW) and
Percentage of Prevalent Patients Waitlisted in Active Status (APPPW),
third column (Outcome), the entry ``Yes'' is corrected to read ``No''.
85. On page 50445, lower third of the page, in the table titled
``Table B.14 Prevention and Treatment of Infectious Disorders Including
Hepatitis C and HIV MVP Clinical Groupings'', third row (Q340: HIV
Medical Visit Frequency), second column (Measure), the parenthetical
phrase ``(Collection Type: MIPS CQM)'' is corrected to read
``(Collection Type: eCQM, MIPS CQM)''.
C. Correction of Errors to the Amendatory Instructions
86. On page 50007,
a. First column, amendatory instruction 8 for Sec. 410.15, lines 1
through 7, the instruction ``Section 410.15 is amended by revising
paragraph (a), the definition for ``First annual wellness visit
providing personalized prevention plan services'' and ``Subsequent
annual wellness visit providing personalized prevention plan services''
is corrected to read ``Section 410.15 is amended in paragraph (a), in
the definitions for ``First annual wellness visit providing
personalized prevention plan services'' and ``Subsequent annual
wellness visit providing personalized prevention plan services'' by
revising paragraphs (xiii) and (xi), respectively.''.
b. Second column,
(1) Amendatory instruction 11 for Sec. 410.62, lines 1 and 2, the
instruction ``Section 410.62 is amended by revising paragraph (a) to
read as follows:'' is corrected to read ``Section 410.62 is amended by
revising paragraph (a) introductory text to read as follows:''.
(2) Amendatory instruction 12 for Sec. 410.79, lines 10 and 11
(12.b.), the instruction ``Revising paragraphs (c)(1)(ii) and
(e)(3)(iii)(c);'' is corrected to read ``Revising paragraphs
(c)(1)(ii), (d) introductory text, and (e)(3)(iii)(c);''.
87. On page 50008, second column, amendatory instruction 14 for
Sec. 414.84, lines 8 and 9 (14.d.), the instruction ``Revising newly
redesignated paragraph (c)(4)(ii)'' is corrected to read ``Revising
newly redesignated paragraphs (c)(4)(ii) and (c)(5)''.
88. On page 50009, beginning at the bottom of the third column and
continuing to the second column on page 50010, second amendatory
instruction 19 for Sec. 414.1305 and its associated regulations text
is removed.
89. On page 50014, second column, amendatory instruction 31 for
Sec. 424.205, the instruction ``Section 424.205 amended by revising
paragraphs (c)(10), (f)(2)(i), and (f)(5) to read as follows:'' is
corrected to read ``Section 424.205 is amended by revising paragraphs
(c)(10), (f)(1)(ii), (f)(2)(i), and (f)(5) to read as follows:''.
List of Subjects
42 CFR Part 405
Administrative practice and procedure, Diseases, Health facilities,
Health professions, Medical devices, Medicare, Reporting and
recordkeeping requirements, Rural areas, X-rays.
42 CFR Part 410
Diseases, Health facilities, Health professions, Laboratories,
Medicare, Reporting and recordkeeping requirements, Rural areas, X-
rays.
42 CFR Part 414
Administrative practice and procedure, Biologics, Diseases, Drugs,
Health facilities, Health professions, Medicare, Reporting and
recordkeeping requirements.
42 CFR Part 425
Administrative practice and procedure, Health facilities, Health
professions, Medicare, Reporting and recordkeeping requirements.
42 CFR Part 427
Administrative practice and procedure, Biologics, Medicare,
Prescription drugs.
42 CFR Part 428
Administrative practice and procedure, Biologics, Medicare,
Prescription drugs.
42 CFR Part 512
Administrative practice and procedure, Health care, Health
facilities, Health insurance, Intergovernmental relations, Medicare,
Penalties, Privacy, Reporting and recordkeeping requirements.
Accordingly, 42 CFR chapter IV is corrected by making the following
correcting amendments to parts 405, 410, 414, 425, 427, 428, and 512:
PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
0
1. The authority citation for part 405 continues to read as follows:
Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x,
1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).
0
2. Section 405.2463 is amended by revising paragraph (b)(3)
introductory text to read as follows:
Sec. 405.2463 What constitutes a visit.
* * * * *
(b) * * *
(3) Visit-Mental health. A mental health visit is a face-to-face
encounter or an encounter furnished using interactive, real-time, audio
and video telecommunications technology or audio-only interactions in
cases where the patient is not capable of, or does not consent to, the
use of video technology for the purposes of diagnosis, evaluation or
treatment of a mental health disorder. Not before October 1, 2025, in
the case of mental health visits furnished via
[[Page 12079]]
interactive, real-time, audio and video telecommunications technology
or audio-only interactions, within 6 months prior to the furnishing of
the telecommunications service and that an in-person mental health
service (without the use of telecommunications technology) must be
provided at least every 12 months while the beneficiary is receiving
services furnished via telecommunications technology for diagnosis,
evaluation, or treatment of mental health disorders, unless, for a
particular 12-month period, the physician or practitioner and patient
agree that the risks and burdens outweigh the benefits associated with
furnishing the in-person item or service, and the practitioner
documents the reasons for this decision in the patient's medical
record, between an RHC or FQHC patient and one of the following:
* * * * *
PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
0
3. The authority citation for part 410 continues to read as follows:
Authority: 42 U.S.C. 1302, 1395m, 1395hh, 1395rr, and 1395ddd.
0
4. Section 410.26 is amended by revising paragraph (a)(2) to read as
follows:
Sec. 410.26 Services and supplies incident to a physician's
professional services: Conditions.
(a) * * *
(2) Direct supervision means the level of supervision by the
physician (or other practitioner) of auxiliary personnel as defined in
Sec. 410.32(b)(3)(ii). The presence of the physician (or other
practitioner) required for direct supervision may include virtual
presence through audio/video real-time communications technology
(excluding audio-only) for services without a 010 or 090 global surgery
indicator.
* * * * *
0
5. Section 410.79 is amended by adding paragraph (d)(1)(i) to read as
follows:
Sec. 410.79 Medicare Diabetes Prevention Program expanded model:
Conditions of coverage.
* * * * *
(d) * * *
(1) * * *
(i) The curriculum furnished during the make-up session must
address the same CDC-approved DPP curriculum topic as the regularly
scheduled session that the beneficiary missed;
* * * * *
PART 414--PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
0
6. The authority citation for part 414 continues to read as follows:
Authority: 42 U.S.C. 1302, 1395hh, and 1395rr(b)(l).
0
7. Section 414.84 is amended by revising paragraph (c)(5) to read as
follows:
Sec. 414.84 Payment for MDPP services.
* * * * *
(c) * * *
(5) Current Procedural Terminology (CPT) Modifier 76 (repeat
services by same physician) must be appended to any claim for G9886,
G9887, or G9871 to identify a MDPP make-up session that was held on the
same day as a regularly scheduled MDPP session.
* * * * *
0
8. Section 414.1305 is amended by--
0
a. Revising the introductory text for the definitions of ``Attribution-
eligible beneficiary'', ``Covered professional service attribution-
eligible beneficiary'', and ``E/M attribution-eligible beneficiary''.
0
b. Revising the definitions of ``QP patient count threshold'' and ``QP
payment amount threshold''.
The revisions read as follows:
Sec. 414.1305 Definitions.
* * * * *
Attribution-eligible beneficiary means, effective through the 2025
QP Performance Period, a beneficiary who, during the QP Performance
Period:
* * * * *
Covered professional service attribution-eligible beneficiary
means, effective starting with the 2026 QP Performance Period, a
beneficiary who, during the QP Performance Period:
* * * * *
E/M attribution-eligible beneficiary means, effective starting with
the 2026 QP Performance Period, a beneficiary who, during the QP
Performance Period:
* * * * *
QP patient count threshold means the minimum threshold score
specified in Sec. 414.1430(a)(3) and (b)(3) that an eligible clinician
must attain through a patient count methodology described in Sec. Sec.
414.1435(b), (d), or (f) and 414.1440(c) to become a QP for a year.
QP payment amount threshold means the minimum threshold score
specified in Sec. 414.1430(a)(1) and (b)(1) that an eligible clinician
must attain through the payment amount methodology described in
Sec. Sec. 414.1435(a), (c), or (e) and 414.1440(b) to become a QP for
a year.
* * * * *
0
9. Section 414.1380 is amended by:
0
a. Revising paragraphs (b)(1)(iii) and (vi) and (b)(2)(iii)
introductory text; and
0
b. Adding paragraph (b)(2)(vi).
The revisions and addition read as follows:
Sec. 414.1380 Scoring.
* * * * *
(b) * * *
(1) * * *
(iii) Minimum case requirements. Except as otherwise specified in
the MIPS final list of quality measures described in Sec.
414.1330(a)(1), the minimum case requirement is 20 cases.
* * * * *
(vi) Improvement scoring. Improvement scoring is available to MIPS
eligible clinicians that demonstrate improvement in performance in the
current MIPS performance period compared to performance in the
performance period immediately prior to the current MIPS performance
period based on measure achievement points.
(A) Improvement scoring is available when the data sufficiency
standard is met, which means when data are available and a MIPS
eligible clinician has a quality performance category achievement
percent score for the previous performance period and the current
performance period.
(1) Data must be comparable to meet the requirement of data
sufficiency which means that the quality performance category
achievement percent score is available for the current performance
period and the previous performance period and quality performance
category achievement percent scores can be compared.
(2) Quality performance category achievement percent scores are
comparable when submissions are received from the same identifier for
two consecutive performance periods.
(3) If the identifier is not the same for two consecutive
performance periods, then for individual submissions, the comparable
quality performance category achievement percent score is the highest
available quality performance category achievement percent score
associated with the final score from the prior performance period that
will be used for payment for the individual. For group, virtual group,
and APM Entity submissions, the comparable quality performance category
achievement percent score is the average of the quality performance
category achievement percent score
[[Page 12080]]
associated with the final score from the prior performance period that
will be used for payment for each of the individuals in the group.
(4) Improvement scoring is not available for clinicians who were
scored under facility-based measurement in the performance period
immediately prior to the current MIPS performance period.
(B) The improvement percent score may not total more than 10
percentage points.
(C) The improvement percent score is assessed at the performance
category level for the quality performance category and included in the
calculation of the quality performance category score as described in
paragraph (b)(1)(vii) of this section.
(1) The improvement percent score is awarded based on the rate of
increase in the quality performance category achievement percent score
of MIPS eligible clinicians from the previous performance period to the
current performance period.
(2) An improvement percent score is calculated by dividing the
increase in the quality performance category achievement percent score
from the prior performance period to the current performance period by
the prior performance period quality performance category achievement
percent score multiplied by 10 percent.
(3) An improvement percent score cannot be lower than zero
percentage points.
(4) Beginning with the CY 2018 performance period/2020 MIPS payment
year, we will assume a quality performance category achievement percent
score of 30 percent if a MIPS eligible clinician earned a quality
performance category score less than or equal to 30 percent in the
previous year.
(5) The improvement percent score is zero if the MIPS eligible
clinician did not fully participate in the quality performance category
for the current performance period.
(D) For the purpose of improvement scoring methodology, the term
``quality performance category achievement percent score'' means the
total measure achievement points divided by the total available measure
achievement points, without consideration of measure bonus points or
improvement percent score.
(E) For the purpose of improvement scoring methodology, the term
``improvement percent score'' means the score that represents
improvement for the purposes of calculating the quality performance
category score as described in paragraph (b)(1)(vii) of this section.
(F) For the purpose of improvement scoring methodology, the term
``fully participate'' means the MIPS eligible clinician met all
requirements in Sec. Sec. 414.1335 and 414.1340.
* * * * *
(2) * * *
(iii) Excluding cost measure scores calculated for informational-
only purposes as provided in paragraph (b)(2)(vi) of this section, the
cost performance category score is the sum of the following, not to
exceed 100 percent:
* * * * *
(vi) Beginning with the 2028 MIPS payment year, CMS calculates a
score for each new cost measure in accordance with the scoring policy
set forth in this paragraph (b)(2) for informational-only purposes
during the measure's informational-only feedback period.
(A) For the purposes of this paragraph (b)(2)(vi), the following
terms have the following meanings.
(1) New cost measure means a measure that CMS has newly specified
for the MIPS cost performance category for a performance period under
Sec. 414.1350 beginning with the 2028 MIPS payment year. This term
excludes any cost measures that CMS has specified for the MIPS cost
performance category prior to the 2028 MIPS payment year or CMS
modifies at any time.
(2) Informational-only feedback period means a 2-year period
beginning with the first day of the first performance period and ending
with the final day of the second performance period for the two
applicable MIPS payment years for which CMS initially has specified the
new cost measure.
(B) During a new cost measure's informational-only feedback period,
CMS does not include any scores for the new cost measure calculated for
informational-only purposes under this paragraph (b)(2)(vi) in CMS's
calculation of a MIPS eligible clinician's cost performance category
score under paragraph (b)(2)(iii) of this section or a MIPS eligible
clinician's MIPS final score under paragraph (c) of this section.
(C) During a new cost measure's informational-only feedback period,
CMS confidentially provides each MIPS eligible clinician their measure
score under this paragraph (b)(2)(vi) for informational-only purposes.
CMS also provides performance feedback to the MIPS eligible clinician
in accordance with section 1848(q)(12) of the Act.
(D) Upon completion of a new cost measure's informational-only
feedback period, CMS includes its calculation of any scores for the
cost measure in CMS's calculation of a MIPS eligible clinician's cost
performance category score under paragraph (b)(2)(iii) of this section
and a MIPS eligible clinician's MIPS final score under paragraph (c) of
this section.
* * * * *
0
10. Section 414.1435 is amended by--
0
a. Removing paragraphs (2) and (3) following paragraph (b)(4); and
0
b. Revising paragraph (h).
The revision reads as follows:
Sec. 414.1435 Qualifying APM participant determination: Medicare
option.
* * * * *
(h) Use of methods. (1) CMS calculates Threshold Scores for an APM
Entity or eligible clinician as provided by Sec. 414.1425(b) under
either of the following:
(i) For QP status determination through QP performance period 2025,
both the payment amount and patient count methods described in
paragraphs (a) and (b) of this section for each QP Performance Period.
(ii) For QP status determination starting with QP performance
period 2026, all of the methods described in paragraphs (c) through (f)
of this section for each QP Performance Period.
(2) CMS assigns to the eligible clinicians included in the APM
Entity group or to the eligible clinician the score that results in the
greater QP status. QP status is greater than Partial QP status, and
Partial QP status is greater than no QP status.
PART 425--MEDICARE SHARED SAVINGS PROGRAM
0
11. The authority citation for part 425 continues to read as follows:
Authority: 42 U.S.C. 1302, 1306, 1395hh, and 1395jjj.
0
12. Section 425.512 is amended by revising paragraphs (c)(3)(ii)
through (iv) to read as follows:
Sec. 425.512 Determining the ACO quality performance standard for
performance years beginning on or after January 1, 2021.
* * * * *
(c) * * *
(3) * * *
(ii) For performance year 2023, if the ACO reports quality data via
the APP and meets data completeness and case minimum requirements, CMS
will use the higher of the ACO's quality score or the equivalent of the
30th percentile MIPS Quality performance category score across all MIPS
Quality performance category scores, excluding entities/providers
eligible for facility-based scoring, for the relevant performance year.
(iii) For performance year 2024, if the ACO reports quality data
via the APP
[[Page 12081]]
and meets the data completeness requirement at Sec. 414.1340 of this
subchapter and receives a MIPS Quality performance category score under
Sec. 414.1380(b)(1) of this subchapter, CMS will use the higher of the
ACO's quality score or the equivalent of the 40th percentile MIPS
Quality performance category score across all MIPS Quality performance
category scores, excluding entities/providers eligible for facility-
based scoring, for the relevant performance year.
(iv) For performance year 2025 and subsequent performance years, if
the ACO reports the APP Plus quality measure set and meets the data
completeness requirement at Sec. 414.1340 of this subchapter and
receives a MIPS Quality performance category score under Sec.
414.1380(b)(1) of this subchapter, CMS will use the higher of the ACO's
quality score or the equivalent of the 40th percentile MIPS Quality
performance category score across all MIPS Quality performance category
scores, excluding entities/providers eligible for facility-based
scoring, for the relevant performance year.
* * * * *
PART 427--MEDICARE PART B DRUG INFLATION REBATE PROGRAM
0
13. The authority citation for part 427 continues to read as follows:
Authority: 42 U.S.C. 1395w-3a(i), 1302, and 1395hh.
0
14. Section 427.502 is amended by revising paragraphs (c)(1)(ii) and
(c)(2)(ii) to read as follows:
Sec. 427.502 Rebate Reports for applicable calendar quarters in
calendar years 2023 and 2024.
* * * * *
(c) * * *
(1) * * *
(ii) For this single Preliminary Rebate Report for the applicable
calendar quarters in calendar year 2023, the Suggestion of Error period
as set forth in Sec. 427.503 will be 30 calendar days.
* * * * *
(2) * * *
(ii) Within 9 months after issuance of the single Rebate Report,
CMS will perform one regular reconciliation for the applicable calendar
quarters in calendar year 2024 in order to include revisions to the
information used, determined under Sec. 427.501(b)(1), to calculate
the rebate amount. Such reconciliation will be as determined under
Sec. 427.501(d) inclusive of a preliminary reconciliation and a report
with the reconciled rebate amount.
* * * * *
PART 428--MEDICARE PART D DRUG INFLATION REBATE PROGRAM
0
15. The authority citation for part 428 continues to read as follows:
Authority: 42 U.S.C. 1395w-114b, 1302, and 1395hh.
Sec. 428.402 Rebate Reports for applicable periods beginning October
1, 2022, and October 1, 2023.
0
16. Section 428.402 is amended by revising paragraphs (c)(1)(ii) and
(c)(2)(ii) to read as follows:
* * * * *
(c) * * *
(1) * * *
(ii) The rebate amount will be reconciled within 21 months after
the Rebate Report set forth in this paragraph (c)(1) is issued to
include the information set forth in Sec. 428.401(d)(1)(i)(A) through
(G).
* * * * *
(c) * * *
(2) * * *
(ii) The rebate amount will be reconciled within 9 months after the
Rebate Report and within 33 months after the Rebate Report specified in
this paragraph (c)(2) is issued to include the information determined
under Sec. 428.401(d)(1)(i)(A) through (G).
PART 512--STANDARD PROVISIONS FOR MANDATORY INNOVATION CENTER
MODELS AND SPECIFIC PROVISIONS FOR CERTAIN MODELS
0
17. The authority citation for part 512 continues to read as follows:
Authority: 42 U.S.C. 1302, 1315a, and 1395hh.
0
18. Add an undesignated center heading before Sec. 512.700 to read as
follows:
General
0
19. Section 512.705 is amended by revising the definition of ``ASM
payment year'' to read as follows:
Sec. 512.705 Definitions.
* * * * *
ASM payment year means a calendar year in which CMS applies the ASM
payment multiplier to Medicare Part B payments for covered professional
services based on the final score achieved by that ASM participant for
the ASM performance year 2 years prior.
* * * * *
0
20. Section 512.710 is amended by revising paragraphs (f)(1)
introductory text and paragraph (g)(1)(ii) to read as follows:
Sec. 512.710 Participant eligibility and selection.
* * * * *
(f) * * *
(1) Exclusions. CMS excludes from the selection of CBSAs and
metropolitan divisions applicable areas that meet any of criteria
described in paragraph (f)(1)(i) or (ii) of this section.
* * * * *
(g) * * *
(1) * * *
(ii) Final ASM participants. CMS identifies the final ASM
participants selected for participation starting in the 2027 ASM
performance year/2029 ASM payment year by confirming that the
preliminarily eligible ASM participants identified under paragraph
(g)(1)(i) of this section meet the ASM participant eligibility criteria
using applicable data from CY 2025. The clinicians selected as ASM
participants starting in the 2027 ASM performance year/2029 ASM payment
year is made public in a form and manner determined by CMS.
* * * * *
0
21. Add an undesignated center heading before Sec. 512.715 to read as
follows:
Performance Categories and Scoring
0
22. Section 512.725 is amended by revising paragraph (b)(1) to read as
follows:
Sec. 512.725 Quality ASM performance category.
* * * * *
(b) * * *
(1) Risk-Standardized Acute Unplanned Cardiovascular-Related
Admission Rates for Patients with Heart Failure for the Merit-based
Incentive Payment System (MIPS Q492) with minor modification to the
measure specifications to attribute solely to ASM participants who have
had one (1) or more visits with the beneficiary.
* * * * *
Sec. 512.730 [Amended]
0
23. Section 512.730 is amended by redesignating the second paragraph
(e)(1)(i) as paragraph (e)(1)(ii).
0
24. Section 512.745 is amended by revising paragraphs (a)(3)(i) and
(a)(4)(i) to read as follows:
Sec. 512.745 Final scoring.
(a) * * *
(3) * * *
(i) The complex patient scoring adjustment is limited to ASM
participants with a risk indicator at or above the risk indicator
calculated median for their ASM cohort. To determine the median for the
respective
[[Page 12082]]
risk indicator (HCC and dual eligible proportion) for each ASM cohort,
risk indicators associated to an ASM participant in the corresponding
ASM cohort from the calendar year preceding the applicable ASM
performance year, for all ASM participants within an ASM cohort who
meet the data submission requirements for the quality ASM performance
category at Sec. 512.720(a)(1)(i) are used.
* * * * *
(4) * * *
(i) Scoring adjustment for an ASM participant that is in a small
practice and is not a solo practitioner. CMS adds 10 points to the
final score of an ASM participant that meets all of the following:
(A) Is in a small practice.
(B) Is not a solo practitioner.
(C) Meets the requirements to receive a final score greater than
zero as described in paragraph (a)(2)(i) of this section for an
applicable ASM performance year.
* * * * *
0
25. Add an undesignated heading before Sec. 512.750 to read as
follows:
Payment and Timely Error Notice Process
0
26. Section 512.750 is amended by--
0
a. Revising paragraphs (c)(1)(i); and
0
b. Redesignating the second paragraph (f)(2) as paragraph (f)(2)(ii).
The revision reads as follows:
Sec. 512.750 Payment adjustment.
* * * * *
(c) * * *
(1) * * *
(i) ASM risk level. CMS sets an ASM risk level that is the
magnitude of the maximum downside and upside risk to which an ASM
participant is subject to during an ASM payment year.
* * * * *
0
27. Add an undesignated center heading before Sec. 512.760 to read as
follows:
Data Sharing, Waivers, Safe Harbor, and Compliance
0
28. Section 512.775 is amended by revising paragraphs (a), (b)(2)
introductory text, and (b)(3)(i) and (ii) to read as follows:
Sec. 512.775 Medicare program waivers.
(a) Medicare payment waivers. Unless otherwise specified in Sec.
512.710(a)(2), CMS waives the requirements of section 1848(q) of the
Act, and its implementing regulations, for an ASM participant for each
ASM performance year that the ASM participant meets the ASM eligibility
criteria set forth in Sec. 512.710(b).
(b) * * *
(2) Waiver of the originating site requirements. Except for the
originating site requirements for a face-to-face encounter for home
health certification, CMS waives the originating site requirements
under section 1834(m)(4)(C)(ii)(I) through (VIII) of the Act for
episodes to permit a telehealth visit to originate in the beneficiary's
home or place of residence solely for services that--
* * * * *
(3) * * *
(i) Under section 1834(m)(2)(B) of the Act so that the facility fee
normally paid by Medicare to an originating site for a telehealth
service is not paid if the service is originated in the beneficiary's
home or place of residence.
(ii) Under section 1834(m)(2)(A) of the Act to allow the distant
site payment for telehealth home visit HCPCS codes unique to ASM.
* * * * *
Liesl I. Fowler,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2026-04797 Filed 3-11-26; 8:45 am]
BILLING CODE 4120-01-P
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